The majority of healthcare providers do not routinely screen, counsel, or refer patients who use or abuse tobacco, alcohol, or illicit drugs, despite the dissemination of numerous guidelines recommending such practices. This is a significant problem with far-reaching consequences, including excess morbidity, premature mortality, and inflated healthcare costs arising from unidentified and untreated substance abuse. In order to address this problem, Polaris Health Directions (Small Business Concern) and Cooper University Hospital/RWJMS (Research Institute) have partnered for this STTR Phase I study to design, create, and field-test the Dynamic Assessment and Referral System for Substance Abuse (DARSSA). The DARSSA will be composed of three integrated modules. The Assessment module will provide for a time- efficient, computerized poly-substance use screening suitable for integration into busy healthcare settings. For substance users who desire treatment, the Referral Generator module will provide a passive or dynamic referral, based on patient preference. Patients who choose the passive referral will receive a list of substance treatment providers tailored to their substance use profile, geographic location, and insurance type. Those that choose the dynamic referral will also have an assessment summary, a signed authorization to release information, and their contact information electronically transmitted to a substance treatment specialist, who will then be responsible for contacting the patient to discuss treatment options. This process will rely on an extensive referral library maintained by Polaris Health Directions and secure, HIPAA-compliant transmittal technologies. Finally, the Report Generator module will use the assessment data to create two summaries: (1) the Counseling Guide, which will assist healthcare provider counseling efforts, and (2) the Patient Report, which will act as personalized feedback and will summarize the referral results. The DARSSA's innovations will include: (1) features facilitating integration into a range of healthcare settings; (2) an automated referral system promoting linkage with specialized treatment services; (3) longitudinal tracking and reporting capability; and, (4) predictive modeling of treatment engagement. Early end-user involvement will help to ensure relevance, practicality, and acceptability of the program. After debugging and preliminary testing, the Project Team will field-test the DARSSA prototype using 80 participants drawn from two diverse settings, including a coronary care unit (n=40) and an emergency department (n=40). End-user evaluations from the field-test will be compared to pre-established acceptability criteria and will guide the Phase II submission. The DARSSA's commercial potential is considerable, with an anticipated favorable return on investment from: (1) increased compliance with JCAHO regulatory mandates to counsel tobacco users, (2) cost savings from reduced substance abuse, and (3) enhanced revenue generation through increased reimbursable counseling (e.g., Medicare). [unreadable] [unreadable] [unreadable]